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Impacts of ICD – 10

US Health care System is very keenly introspecting on ICD-10 transitions and October 2015 implementation deadline. All involved players are both apprehensive and anxious to be a part of the change as well as the adaptability to the foresaid changes. This is been compared mostly with theY2K change, which drew much speculation and confusion.

On the contrary, ICD-10 transition is sketched systematically, with enough time to inculcate changes, with detailed and more described diagnosis, signs, and symptoms for a very effectively documented medical report and thus coding and finally a better reimbursement.

However, the transition to ICD-10 does not directly affect provider use of the Current Procedural Terminology (CPT) and Health Care Common Procedure Coding System (HCPCS) codes.

Partners of the change

  • Hospitals
  • Health care practitioners and institutions
  • Health insurers and other third-party payers
  • Electronic-transaction clearinghouses
  • Hardware and software manufacturers and vendors
  • Billing and practice management service providers
  • Health care administrative and oversight agencies
  • Public and private health care research institutions

Restrictions of ICD-9

  • ICD-9 has several limitations that prevent complete, precise coding and billing of health conditions & treatments.
  • The 30-year-old code set contains outdated vocabulary and is incoherent with current medical practice.
  • The code length and alphanumeric structure limit the number of new codes that can be shaped and many ICD-9 categories are already full.

The codes themselves lack specificity and detail to support the following:

  1. Precise anatomical descriptions
  2. Differentiation of risk and severity
  3. Key parameters to differ manifestations
  4. Optimal claim reimbursement

The lack of detail limits the ability of payers and others to analyze information such as health care utilization, costs and outcomes, resource use and allocation, and performance measurement.

The codes do not provide the level of detail necessary to further streamline automated claim processing, which would result in fewer payer-physician inquiries and potential claim payment delays or denials.